Effectiveness of pre-emptive thoracic epidural analgesia for acute post thoracotomy pain relief: a randomised blinded study

Background: Thoracotomy is one of the most damaging surgical insults on respiratory mechanics and management of post-thoracotomy pain is a challenge. This study was conducted to compare intensity of postoperative pain, measured by VAS, in patients receiving Pre-emptive TEA compared to patients receiving epidural analgesia during surgical closure.Method: Group A comprised of patients receiving Pre-emptive TEA with 0.1%Ropivacaine and 2 μg/ml fentanyl, 20 minutes before incision. Group B comprised of patients receiving the same drug, during surgical closure.Results: Demographic profile was comparable between both groups. Both groups offered good analgesia, but pre-emptive group took an upper hand upto4th postoperative hour (p<0.05), both at rest and coughing. Beyond 4thhour, analgesic efficacy of both groups was comparable.Conclusion: Pre-emptive technique offered better analgesia over the postoperative technique up to 4th postoperative hour, both at rest and coughing.

Clinical Profile And Outcome Of Paraquat Poisoning Induced Acute Kidney Injury

Paraquat poisoning is one of the causes of AKI, the mechanism of toxicity being the production of reactive oxygen species,thereby causing toxicity at the cellular level. The aim of this study is to determine the requirement of haemodialysis and the severity of toxicity, depending upon the amount ingested.It is found that in Paraquat poisoning, the intervention with pre–emptive haemodialysisis not useful in decreasing the mortality. Ingestion under the influence of alcohol has higher mortality.Amount of poison ingested has a great impact and is directly proportional to the mortality. Oral ulcers, hepatic involvement, ARDS and MODS all reflected grave prognosis ultimately leading to death. The overall mortality in the study is 51%.

Preemptive and Postoperative Medication Protocols for Root Coverage Combined with Connective Tissue Graft

Abstract This trial evaluated the preemptive and postoperative effect of dexamethasone and ibuprofen on prevention of pain/discomfort, edema and interference in daily life in patients undergoing root coverage combined with subepithelial connective tissue graft (CAF + CTG). Twenty patients were randomly assigned as follows: NSAID Group: 400mg Ibuprofen 60 min preemptive + 400mg Ibuprofen postoperative; or SAID Group: 4mg Dexamethasone 60 min preemptive + 4mg Dexamethasone postoperative. The postoperative medication was administered 8 and 16 h post-surgery. Each patient received questionnaires based on a numeric scale (101-point numeric scale rate [NRS-101]) and multiple choice questions (four-point verbal rating scale [VRS-4]) about trans-operative pain/discomfort, hourly for 8 h after surgery and once a day for three days. A Visual Analogue Scale (VAS) for edema and interference in daily life during the 1st, 2nd, 3rd and 7th day was also answered. The degree of anxiety was rated statistically by the Chi-square test. The Mann-Whitney and Friedman tests were used for the other questionnaires. The surgery time and number of analgesic pills consumed were compared using Student's t-test. Patients who used dexamethasone presented a trend toward less pain when compared to individuals who ingested ibuprofen, with a significant difference observed 3 h after the procedure (p<0.05). The use of dexamethasone also promoted less edema until the 2nd day and lower interference in daily life on the third day when compared with ibuprofen (p<0.05). We concluded that the use of dexamethasone as a preemptive and postoperative medication was more suitable as a drug therapeutic protocol for CAF + CTG.

Resumo Este estudo avaliou o efeito preventivo e pós-operatório de dexametasona e ibuprofeno na prevenção da dor, desconforto, edema e interferência na vida diária, em pacientes submetidos ao recobrimento radicular associado a enxerto de tecido conjuntivo subepitelial (CAF + CTG). Vinte pacientes foram divididos aleatoriamente: Grupo AINES: Ibuprofeno 400 mg 60 min antes da cirurgia + Ibuprofeno 400 mg no período pós-operatório e Grupo AIES: 4 mg de dexametasona 60 min antes da cirurgia + Dexametasona 4mg no pós-operatório. A medicação pós-operatória foi administrada 8 e 16 horas pós-cirurgia. Cada paciente recebeu questionários com base na escala numérica NRS-101 (101 pontos numéricos) e perguntas de múltipla escolha (VRS-4) sobre dor / desconforto no período transoperatório, de hora em hora durante 8 h e uma vez por dia durante três dias após a cirurgia. A Escala Visual Analógica (VAS) para análise de edema e interferência na vida diária também foi respondida no 1º, 2º, 3º e 7º dia após a cirurgia. O grau de ansiedade foi estatisticamente avaliado pelo teste do Qui-quadrado. Mann-Whitney e Friedman foram utilizados para os demais questionários. Para o tempo de cirurgia e o número de analgésicos consumidos, o teste t de Student foi aplicado. Os pacientes que utilizaram dexametasona apresentaram uma tendência para menores níveis de dor quando comparados aos indivíduos que ingeriram ibuprofeno, com diferença significativa observada 3 h após o procedimento cirúrgico (p<0,05). A utilização de dexametasona também promoveu menores níveis de edema até ao segundo dia e menor interferência na vida diária no terceiro dia, quando comparada com o ibuprofeno (p<0,05). Concluiu-se que a utilização de dexametasona como medicamento preventivo e pós-operatório mostra ser mais adequado como protocolo medicamentosos para cirurgias de recobrimento radicular com associação de enxerto de tecido conjuntivo.

Pre-emptive Analgesia Effects of Hydromorphone on Stress Reaction in Patients Undergoing Gynecological Laparoscopic Surgery / 医药导报

Objective To investigate the pre-emptive analgesia effects of hydromorphone on stress reaction in patients undergoing gynecological laparoscopic surgery.Methods Forty ASA Ⅰ or Ⅱ patients [age:45-58 years,body mass index:18-24 kg· (m2)-1] undergoing gynecological laparoscopic surgery were randomly divided into 2 groups (n =20 for each group):treatment group and control group.Hydromorphone (1 mg) was intravenously injected before anesthesia in treatment group.In the two groups,after routine induction and incubation,remifentanil (0.2 μg· min-1 · kg-1) and propofol (0.1 mg· min-1· kg-1) were injected with micro perfusion pump,cisatracurium was injected intermittently.Injection of remifentanil and propofol was stopped when skin suture started.The concentrations of epinephrine(E) and norepinephrine(NE) were obtained before induction (t1),pneumoperitoneum (t2),1 h after pneumoperitoneum (t3) and extubation (t4),respectively.The heart rate,blood pressure and the time of operation to extubation of the patients were recorded.Results There were no significant changes in extubation time after operation among the groups.Heart rate and systolic blood pressure were significantly lower in the treatment group than in the control group (P ＜ 0.05).Plasma E and NE levels at t1 were significantly lower than those at t2,t3 and t4.Plasma E and NE were significantly lower in treatment group than that of control group at t2,t3 and t4 (P ＜ 0.05).Conclusion Pre-emptive analgesia of hydromorphone can significantly decrease the release of epinephrine and norepinephrine during and after laparoscopic surgery,restrain the increase of heart rate and systolic blood pressure during extubation,without influence of revival time.

Clinical study on foscarnet prophylaxis and pre-emptive therapy for cytomegalovirus infection in hematopoietic stem cell transplantation / 白血病·淋巴瘤

Objective To observe the clinical safety and efficacy of foscarnet prophylaxis and pre-emptive therapy for cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Ninety-six patients undergoing allo-HSCT from October 2014 to December 2016 were retrospectively analyzed. Plasma CMV-DNA was monitored with real-time quantitative polymerase chain reaction (RQ-PCR) from beginning to 180 days after transplantation. Foscarnet was used not only for prophylaxis but also for first-line pre-emptive therapy when plasma CMV-DNA turned to positive. Foscarnet was given 60 mg·kg-1·d-1 and 120 mg·kg-1·d-1 respectively in prevention and pre-emptive therapy. Incidences of CMV infection and CMV disease were observed, influencing factors on CMV in faction and the efficacy and safety of foscarnet prophylaxis were analyzed, and survival of patients treated by all-HSCT was evaluated. Results Of the total 96 patients, 42 cases (43.8%) had CMV infection with the median time of 42 days after allo-HSCT. CMV-DNA became negative in 36 patients (85.7%, 36/42) after pre-emptive therapy. Six patients (14.3 %, 6/42) developed CMV disease, including 5 patients with CMV negative and 1 patient died for CMV pneumonia. Haploidentical donor and grade Ⅱ-Ⅳacute graft versus host disease (GVHD) were the risk factors for CMV reactivation (χ2 = 3.834, P< 0.05; χ2 = 16.807, P< 0.001). The side effects of foscarnet prophylaxis were mild without hematologic toxicities. 12 patients (28.6 %) died in 42 patients with CMV infection, and 6 patients (11.1 %) died in 54 patients without CMV infection. The difference of survival rates between both groups was not statistically significant. Conclusion Foscarnet is an effective agent for prophylaxis and pre-emptive therapy in CMV infection after allo-HSCT with mild adverse reactions, especially for patients following with hematopoietic recovering.

Comparison of Role of Different Doses of Rectal Paracetamol with Rectal Diclofenac as Pre-emptive Analgesics for Postoperative Pain Relief in Paediatric Surgeries.

Background: Post operative pain is a major concern in children particularly in developing countries were opioids are not freely available. Use of opioids is associated with side effects increasing patient discomfort and delaying patient discharge from hospital. We conducted a study comparing the use of different doses of rectal paracetamol with rectal diclofenac when used as pre-emptive analgesics on postoperative pain and recovery in paediatric patients considering the relative risk of diclofenac to increase bleeding in surgeries like tonsillectomy, cleft lip and cleft palate. Methods: Study groups included 20 patients in each. Group P40 receiving 40 mg/kg rectal paracetamol, Group P20 receiving 20 mg/kg rectal paracetamol, Group D receiving rectal diclofenac 1 mg/kg. Pain scoring was done by TPPPS (Toddler Pre-schooler postoperative pain scale) time to first need of analgesia and total dose of analgesia was noted. The rates of recovery were evaluated by using “Modified Steward Coma Scale”at 5 and 10 minutes after extubation. Results: Time of first demand of analgesic was delayed in Group-P40 as compared to Group-D and Group-P20 and difference was statically significant. TPPPS of the three studied groups varied significantly at different time intervals in favour of Group-P40. Total duration of analgesia in Group- P40 was (646±9.94) min Group- D (501±10.63) min and in Group-P20 (294±23.17) min Total analgesic requirement was also low in Group P40 and the difference between groups was significant. Conclusion: Pre-emptive high dose rectal paracetamol appears to be more effective than rectal diclofenac sodium suppository for postoperative analgesia in children without additional risk of bleeding in surgeries like tonsillectomy and cleft lip and cleft palate repair. Hence, high dose rectal paracetamol can be used as an alternative to diclofenac sodium due to higher risks of bleeding with diclofenac sodium in surgeries with increased risk of bleeding.

Pre-Emptive Tramadol Could Reduce Pain after Ureteroscopic Lithotripsy

PURPOSE: Optimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones. MATERIALS AND METHODS: This prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwent ureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocated to two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analogue scale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effects of tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperative fentanyl consumption, and postoperative analgesic requirement. RESULTS: The average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (p<0.01). The number of patients that required postoperative analgesia was not statistically different between the groups. CONCLUSION: Pre-emptive tramadol did reduce early postoperative pain. The patients who received pre-emptive tramadol were less likely to experience severe post-operative pain.

Steroidal and non-steroidal cyclooxygenase-2 inhibitor anti-inflammatory drugs as pre-emptive medication in patients undergoing periodontal surgery

The aim of the present study was to compare the pre-emptive use of a cyclooxygenase-2 (COX-2) inhibitor with a well established steroidal anti-inflammatory drug for pain and edema relief following periodontal surgery for crown lengthening. Thirty patients requiring periodontal surgery were randomly assigned to receive one of the following medications: selective COX-2 inhibitor or steroidal anti-inflammatory drug, 60 min before the surgical procedure. To examine patient anxiety, a Corah's dental anxiety scale was applied before surgery. Using a visual analog scale, the extent of pain/discomfort during the trans-operative period and immediately after the surgery was measured. Additionally, intensity of pain/discomfort and edema were examined 4, 8, 12 and 24 h postoperatively. With regard to anxiety, no statistical differences between the groups were observed (p>0.05). With respect to the extent of pain/discomfort during the trans-operative, immediate and late postoperative period, data demonstrated no significant differences (p>0.05) between the COX-2 inhibitor and steroidal groups. With regard to edema, intragroup analysis did not reveal any statistically significant difference (p>0.05) during the 24 h following surgery in either group. In conclusion, both anti-inflammatory drugs presented a similar potential for pain and edema relief following periodontal surgery.

O objetivo do presente estudo foi comparar a utilização pré-emptiva de medicamento inibidor da COX-2 (cicloxigenase-2) com uma droga antinflamatória esteroidal amplamente utilizada, para o controle da dor e edema após cirurgia periodontal para aumento de coroa. Trinta pacientes que necessitavam de cirurgia periodontal foram aleatoriamente designados a receber uma das seguintes medicações: inibidor seletivo da COX-2 ou a droga antinflamatória esteroidal, 60 min antes do procedimento cirúrgico. Para avaliar a ansiedade do paciente, a escala de ansiedade ao tratamento dental de Corah foi aplicada antes da cirurgia. Com a utilização de escala analógica visual a extensão de dor/desconforto durante o período trans-cirúrgico e imediatamente após a cirurgia foi mensurada. Adicionalmente, a intensidade de dor/desconforto e edema foram avaliados no periodo pós-operatório tardio 4, 8, 12 e 24 h após o procedimento cirúrgico. Com relação à ansiedade, não foi observada diferença estatística entre os grupos (p>0,05). Com relação à extensão de dor/desconforto durante os períodos trans-cirúrgico e pós operatório imediato e tardio, os dados não demonstraram diferenças entre o grupo que recebeu o inibidor seletivo da COX-2 e o aintinflamatório esteroidal (p>0,05). A avaliação do edema, intragrupo, não revelou diferença estatística durante as primeiras 24 h em nenhum dos grupos estudados (p>0,05). Em conclusão, ambas as drogas antiinflamatórias utilizadas apresentaram um potencial similar no controle da dor e edema após cirurgia periodontal.

Preemptive Use of Ketamine on Post Operative Pain of Appendectomy

BACKGROUND: Although early reviews of clinical findings were mostly negative, there is still a widespread belief for the efficacy of preemptive analgesia among clinicians. In this study, we evaluated whether the preemptive use of ketamine decreases post operative pain in patients undergoing appendectomy. METHODS: In double-blind, randomized clinical trials, 80 adult male patients undergoing an operation for acute appendicitis were studied. Patients were randomly assigned to two groups. In the operating room, patients in the ketamine group received 0.5 mg/kg of ketamine IV 10 minutes before the surgical incision. In the control group, 0.5 mg/kg of normal saline was injected. The pain intensity was assessed at time 0 (immediately after arousal) and 4, 12, and 24 hours postoperatively using the 10 points visual analogue scale (VAS). RESULTS: Eighty patients (40 for both groups) were enrolled in this study. For all of the evaluated times, the VAS score was significantly lower in the ketamine group compared to the control. The interval time for the first analgesic request was 23.1 +/- 6.7 minutes for the case group and 18.1 +/- 7.3 minutes for the control (P = 0.02). The total number of pethidine injections in the first 24 hours postoperatively was 0.6 +/- 0.6 for the case group and 2.0 +/- 0.8 for the controls (P = 0.032). There were no drug side effects for the case group. CONCLUSIONS: A low dose of intravenously administered ketamine had a preemptive effect in reducing pain after appendectomy.

The effect of pre-incision nefopam on postoperative pain after major upper abdomonal surgery

Background: Nefopam a powerful painkiller has been put into clinical use since 1976, effects preemptive analgesia. Objectives: To assess the effect of presurgical IV Nefopam on postoperative pain after major upper abdomonal surgery. Subjects and method: A double-blind randomized controlled trial. 62 patients were divided into 2 groups: Nefopam (N, n = 31) and placebo group (PG, n = 31). Presurgical IV 20 mg Nefopam was used in N.PCA was used for both groups. Postoperative non-painful time (PNPT); VAS/48 hours at rest and on cough; IV Morphine rescue with PCA was measured during postsurgical 48 hour period.Results: PNPT was longer in N 42 \xb1 8,9 vs. 22 \xb1 4,8, p<0,01. Titration dose of morphine, Morphine consumption of first 24 hours, and of another 24 hours were lower in N 5,6 \xb1 1,7; 25,2 \xb1 4,9; 10,1 \xb1 3,6 mg vs. 7,1 \xb1 1,5; 30,1 \xb1 4,5; 13,3 \xb1 2,1, p<0,05 and < 0,01, respectively. VASs under tested conditions during first 16 hours were significant lower in N. Conclusion: Presurgical Nefopam had the effect of pre-emptive analgesia as evidence by a significant VAS decrease during the first 16 hours with lower Morphine consumption of 48 hours .

CMV antigenemia following pediatric hematopoietic stem cell transplantation:risk factors and outcomes / 소아과

PURPOSE: Cytomegalovirus(CMV) infection still remains as a major cause of morbidity and mortality after stem cell transplantation. In this study, we analyzed the results of antigenemia-guided pre-emptive therapy among children with allogeneic hematopoietic stem cell transplantation to determine the incidence and risk factors associated with CMV antigenemia, and evaluated the efficacy of the CMV antigenemia based preemptive therapy. METHODS: We enrolled 213 pediatric patients following allogeneic hematopoietic stem cell transplantation(HSCT), at the Catholic HSCT center between October 1998 and December 2003. Pre-emptive ganciclovir was started when more than 5 CMV Ag-positive cells were detected in matched sibling HSCT, and when any Ag-positive cells were seen in unrelated allogenic HSCT. RESULTS: CMV antigenemia was observed in 88(41.3 percent) of 213 patients on median day 28(day 11-99). In univariated analysis, use of unrelated donors(other than siblings), age of recipient(more than 5 years at transplant) at transplantation, the presence of recipient CMV-IgG before transplantation, TBI-based conditioning regimen and the presence of acute GvHD(grade > or=II) were the risk factors for positive CMV antigenemia. In multivariate analysis, unrelated bone marrow transplantation, positive recipient CMV serology and acute GvHD(grade > or=II) were the independent risk factors for positive CMV antigenemia. CONCLUSION: Risk factors of CMV infection in children were CMV serostatus of the recipient, the source of stem cells, and acute graft-versus-host disease. The pre-emptive therapy based on CMV antigenemia was effective in the prevention of CMV disease.

Evaluation of the effect of preemptive analgesia receiving tramadol combined with local anesthesia in neck surgery / 医学研究生学报

Objective: To evaluate the preemptive analgesia of intravenous tramadol preoperatively in neck-surgery. Methods: Eighty patients, ASAⅠ-Ⅱ,were scheduled for neck-surgery under local anesthesia. Patients were randomly divided into 2 groups (40 cases/group).In group P intravenous tramadol was administered as a bolus dose of 3mg/kg 15min prior to skin incision. Group C received saline as a placebo. The patients-controlled analgesia(PCA) devices were used in all patients after operation. We observed BP, HR,VAS score, the time of first PCA activation, the valid number of press PCA and the total consumption of analgesic after operation. Results:The postoperative VAS was markedly lower in group P compared with the group C in 0-24h( P

The Effects of Intraperitoneal Instillation of Lidocaine before Pneumoperitoneum on Postoperative Pain Score and Intraoperative Changes of Blood Pressure in Patients with a Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: This study was performed to evaluate the effects of pre-emptive subdiaphragmatic instillation of lidocaine before pneumoperitoneum on postoperative pain following a laparoscopic cholecystectomy (LC) and also to evaluate it's effect on the changes of blood pressure during an operation. METHODS: Thirty-three relatively healthy patients for an LC were allocated into the two groups. after the induction of general anesthesia with sodium thiopental, vecuronium, nitrous oxide and enflurane (1-2 vol%), 0.2% lidocaine 200 ml was subdiaphragmatically instilled 10 min before pneumoperitoneum in the lidocaine group (n = 15), and normal saline in the control group (n = 18). The changes of the systolic and mean arterial pressure (SAP and MAP), postoperative pain score, and the number of analgesics used during the postoperative 24 h were compared between two groups. RESULTS: The pain scores at postoperative 1, 3, 6, 12, 18 and 24 h and the number of analgesics used were significantly low in the lidocaine group compared to the control group (P<0.01). The elevations of SAP and MAP during pneumoperitoneum were significantly attenuated in the lidocaine group (P<0.01). CONCLUSIONS: This data suggests that subdiaphragmatic instillation of lidocaine before pneumoperitoneum is effective in the control of postoperative pain following an LC and also effective to attenuate the elevation of blood pressure during pneumoperitoneum. However, further study is needed to evaluate the safety of these methods before recommendation of routine use.

Comparative study on outcomes of pre-emptive renal transplantation and transplantation after dialysis / 中华泌尿外科杂志

Objective To compare the clinical outcomes of pre-emptive renal transplantation and transplantation after dialysis, and to evaluate the safety and advantages of pre-emptive renal transplantation. Methods The data of 50 cases of pre-emptive renal transplantation between January 1999 and January 2003 in our hospital were analyzed.Another 50 cases of renal transplantation after dialysis were selected as control group.The 2 groups were matched in the following variables:age,gender,blood type,cold (warm) ischemic time of the grafts,human leukocyte antigen (HLA),primary diseases, and use of immunosuppressants. The patient/allograft survival,incidence of rejection and delayed graft function were compared. Results The control patients (32/50) were more likely to have received blood transfusion before transplantation than patients of pre-emptive renal transplantation (14/50) (64% vs 28%, P

Effect of pre-emptive analgesia with lornoxicam on pain and the expression of pselectin on platelet after modified radical mastectomy / 中国现代普通外科进展

Objective:To determine whether lornoxicam has a preemptive analgesic effect to the patients who undergo modified radical mastectomy.To study the effect of lonoxicam on platelet function and investigate the surface expression of p-selectin on platelet by a flow-cytometric assay.Methods:After obtaining a written informed consent from patients,sixty ASAⅠ-Ⅱpatients,aged 40-60 yr,weighted 40-60 Kg,who were scheduled for modified radical mastectomy were included in the study.All patients were randomly divided into two groups.Patients underwent breast surgery under general anesthesia,Group I was administered 16mgof lornoxicam iv.30 minutes prior to surgery,Group Ⅱ was administered 4 mL placebo.Two mL blood was drawn from a peripheral vein to analyze the surface expression of p-selectin on platelet,blood sample was collected at three time points:30 minutes prior to surgery,6h and 24h after surgery.Introoperative blood loss and the volume of drainage fluid 24h,48h,and 72h after surgery was documented;PONV and other side effects was recorded.The rescue analgesics was recorded.Result:Group I demonstrated reduced pain scores compared to Group Ⅱ at three specific time points;Great difference for the expression of p-selectin on platelet at certain time point in each group was noted,the postoperative express was higer than that of the preoperation;there were no difference for the expression of p-selectin on platelet between two groups.There were no difference in introoperative blood loss and the volume of drainage fluid between two groups;Great difference for the rescue analgesics was recorded,GroupⅡdemends more analgesics than GroupⅠ.The rate of PONV was similar between two groups,no other side effects were recorded.Conclusion:Lornoxicam administered preemptively appears to reduce pain scores after surgery,which can improve the quality of postoperative analgesia.Lornoxicam has no significant effect on platelet activation and aggregation with only one dose before surgery,there is no effect in the quality of blood coagulation.Lornoxicam may be safely used in perioperative period.

Pre-emptive Analgesia: The Effect of Low-Dose Ketamine on the Postoperative Pain after Circumcision with Unilateral Hydrocelectomy in Children / 대한마취과학회지

Backgrounds: Brief noxious stimuli are found to produce long-lasting neuronal sensitization. This cumulative depolarization results from the activation by glutamate of N-methyl-D-aspartic acid (NMDA) receptor. Ketamine at subanesthetic doses blocks the channel associated with the NMDA receptor. The aim of this study was to investigate the pre-emptive effect of ketamine in children after circumcision with unilateral hydrocelectomy. MATERIALS AND METHODS: We have compared the effect of preoperative ketamine (0.3 mg/kg) in a double-blind, randomized study, which was approved by the local Ethics Committee. Informed consents were obtained from their parents. After induction of anesthesia, patients were allocated randomly to receive a ketamine (n=20) or placebo (n=20) intravenously before surgery. Postoperative pain was rated on a faces scale for the first 24 hours. If pain occurred, children received tiaprofenic acid in a dose related to body weight. The cumulative pain score, the time of the first requirement of analgesics, and total requirement of analgesics for 24 hours were also checked. RESULTS: The pain scores at 4, 5, 6, 7, 8, 9, and 12 hours after operation were significantly low in ketamine group. The cumulative pain scores for the first 8 hours and the total requirements of analgesics were significantly low in ketamine group. The time of the first requirement of analgesic was significantly delayed in ketamine group. CONCLUSIONS: Preoperative ketamine in the pediatric circumcision with unilateral hydrocelectomy is effective on the reducing the intensity of the postoperative pain. The results of this study support the theory of pre-emptive analgesia of ketamine.

Analgesic Effects of Preoperative Versus Postoperative Tiaprofenic Acid in Pediatric Tonsillectomy & Adenoidectomy / 대한마취과학회지

BACKGROUND: The aim of this study was to investigate the pre-emptive effect of preoperative intravenous tiaprofenic acid in children aged 4~11 years after tonsillectomy and adenoidectomy. METHODS: We compared in 45 children the effect of preoperative with postoperative tiaprofenic acid (5 mg/kg) on pain after tonsillectomy and adenoidectomy, which was approved by Ethics Committee. Informed consents were obtained from all their parents. After induction of anesthesia, patients were allocated randomly to receive a tiaprofenic acid intravenously either before (n=15) or immediately after (n=15) surgery. The control group was received saline (n=15). Postoperative pain was rated on a faces scale for postoperative 48 hours. Tiaprofenic acid was given when patient complained pain. The cumulative pain score within 3 hours and 48 hours, time to the first analgesic administration, total requirement of analgesics for 48 hours and the first time of swallowing 50 ml water were checked. RESULTS: Postoperative pain score of the preoperative group was significantly lower than the postoperative group at 9, 42, and 48 hours after operation. The cumulative pain scores during the first 3 hours were 15+/-4 (p <0.05 vs postoperative), 21+/-7 and 22+/-5 in pre, postoperative and saline groups respectively. The cumulative pain scores for 48 hours were 40+/-18 (p <0.05 vs postoperative), 61+/-17 and 63+/-18 in pre, postoperative and saline groups respectively. The times of the first swallowing were 6 (5~6)(p <0.05 vs postoperative) hours, 7 (6.7~9)hours, and 8 (4.5~8.7)hours after operation in pre, postoperative, and saline groups respectively. CONCLUSIONS: Preoperative tiaprofenic acid in the tonsillectomy and adenoidectomy was effective on the reducing the intensity of the postoperative pain. The time to the first swallowing was shorter in the preoperative than postoperative group. The results of this study support the theory of pre-emptive analgesia.

Comparison of Preoperative with Postoperative Tiaprofenic Acid on Pain after Adult Local Tonsillectomy / 대한마취과학회지

BACKGREOUND: The aim of this study was to compare the pre-emptive effect of preoperative with postoperative tiaprofenic acid in adult local tonsillectomy. METHODS: We compared in forty adults the effect of preoperative with postoperative tiaprofenic acid on pain after tonsillectomy in a double-blind, randomized study, which was approved by the Ethics Committee. Informed consents were obtained. Patients were allocated randomly to receive a tiaprofenic acid (200 mg) intravenously either before (n=20) or immediately after (n=20) surgery. Postoperative pain was rated by self-rating visual analog scale for the first 24 hours. Tiaprofenic acid (200 mg) was given when patient complained pain. Time to the first analgesic administration, total requirement of analgesics for 48 hours and the first time of swallowing 100 ml water were checked. RESULTS: Postoperative 1 hour pain score of the preoperative group was significantly lower than postoperative groups (p<0.05). Times to the first analgesic administration, the total requirement of analgesics for 48 hours and the times of the first swallowing of 100 ml water were not significantly different between the two groups. CONCLUSIONS: Preoperative intravenous tiaprofenic acid (200 mg) in adult local tonsillectomy was effective on the reducing the intensity of the postoperative pain only 1 hour after operation. The use of preoperative tiaprofenic acid in adult local tonsillectomy was associated with a more calm recovery. The results of this study do not support the theory of preemptive analgesia.

Effect of Pre-vs. Post-incisional Lidocaine Infiltration on Postoperative Pain after Inguinal Herniorrhaphy / 대한마취과학회지

BACKGROUND: Recently many studies reported that the postoperative pain was prevented or decreased from preoperative regional anesthesia by preventing the establishment of central sensitization(pre-emptive analgesia). Therefore, we evaluated the efficacy of preincisional lidocaine infiltration on the postoperative pain. METHODS: We conducted a study to compare preinfiltrating group with 1% lidocaine (30 ml), postinfiltrating group with 1% lidocaine (30 ml) and non-infiltrating group in 45 patients scheduled for elective inguinal herniorrhaphy. During operation, all patients received a general anesthesia with thiopental, isoflurane and nitrous oxide in oxygen. Postoperatively, pain scores on visual analogue scale (VAS) and on verbal rating scale(VRS) at rest, coughing and movement from supine into sitting position were assessed. Also the time to first request for an on-demand postoperative analgesics and the total dose of postoperative analgesics were assessed. And the number of patients who didn't require any analgesics during postoperative period was assessed. RESULTS: The VAS and VRS at rest, coughing, movement were low in preinfiltrating group than in non-infiltrating group and postinfiltrating group postoperatively, but it was statistically significant only in early postoperative period. The time to first request for an on-demand postoperative analgesics occurred later in preinfiltrating group than in non-infiltrating group and in postinfiltrating group and the total dose of supplemental analgesics (ketorolac) was smaller in the preinfiltrating group than in non-infiltrating group and postinfiltrating group, and the patients without analgesic treatment was less in the preinfiltrating group than in non-infiltrating group and postinfiltrating group, but it was not statistically significant. CONCLUSIONS: In patients with inguinal herniorrhaphy, we can not support the pre-emptive analgesia clinically with preincisional lidocaine infiltration.

Pre-emptive Infiltration of Lidocaine Reduces Formalin Pain Behavior in Rat / 대한마취과학회지

Surgical tissue damage induces dual phenomenon of peripheral and central sensitization. Postoperative pain could be partially explained by neuronal hyperexcitability. As a postoperative pain model, formalin test, subcutaneous injection of formalin in the rat hind paw, results in initial vigorous flinching(phase 1), depends on acute chemical stimulation, followed by cessation of activity, and then resumption of flinching(phase 2), which depends on central sensitization. Pre-emptive analgesia, given before the onset of a painful stimuli, reduces or ptevents postoperative pain by preventing this central sensitization. This study was performed to evaluate the effect of local infiltration of lidocaine as a pre-emptive analgesia in the formalin test. Forty experimental rats were divided four groups; CONTROL group(without any treatment), POST group(0.04 mL of 1% lidocaine injection 5 min after formalin injection), PRE group(0.04mL of 1% lidocaine 5 min before formalin injection), and SHAM group(injection of normal saline 5 min before formalin injection). All animals received inhalation anesthesia for 15 min before and 5 min after formalin injection. Under halothane inhalation anesthesia, all were injected subcutaneously 0.04 mL of 5% formalin in the distal plantar area of right hind paw. After recovery of anesthesia, the formalin-induced flinching behavior was observed during only the phase 2 period(10-60 min) after formalin injection. The time to first flinching, the mean number of flinches per min, and the mean number of total flinches during phase 2 expressed as a percent of the values of the CONTROL group were compared between the groups with an t-test or an ANOVA. The first flinching was appeared before recovery of anesthesia in CONTROL and SHAM groups. The time to first flinching after formalin injection was 21.2+/-3.4, 16.6+/-3.1 min respectively in PRE and POST groups. It was significantly longer in PRE group than in POST group(P<0.05), despite of 10 min earlier injeetion of lidocaine in PRE group. The mean number of flinches per min was significantly lower in PRE and POST groups(P<0.05) until 25 min after formalin injection, and after that time the difference between PRE group and POST group was significant(P<0.05). The means of the total number of flinches during phase 2, expressed as a percent of the values of the CONTROL poup, were 100+/-17.2%, 31.8+/-13.1%, 76.9+/-14.5% respectively in SHAM, PRE and POST groups. Those in PRE and POST groups were significantly lower than that of CONTROL group(P<0.001), and the difference between PRE group and POST group was significant(P<0.05). In summary, pre-emptive infiltration of lidocaine on formalin test prolongs the duration of analgesia and reduces the severity of formalin pain in rat. Therefore, the infiltration of lidocaine before formalin test is really provided pre-emptive analgesia.